This invention relates to anchoring devices for retractors and/or for lifting the cavity walls, being attached to the internal surface of a cavity or to various organs within a cavity, during minimally invasive surgery.
More specifically, the invention relates to minimally invasive or preferentially non-invasive anchoring system and devices for attachment to the internal walls of the cavity, or on the organs within a cavity in which the intervention is performed, at another location than the orifice through which they were originally introduced.
Preferably, the device can be moved and re-attached, one or more times, non-invasively or minimally invasively, to other locations in the interior of the cavity. Such devices are denoted throughout the patent application as virtual ports. The purpose of such virtual port devices is to supply an anchoring device for retracting various tissue and organs by self-retained retractor means, or to supply an anchoring device for instruments which are attached to these virtual port devices.
This anchoring permits instruments within the cavity to be moved in any possible direction and at any angle. Such devices may comprise attachment of the device on the underside of the cavity, or on internal organs and tissues, by magnetic attachment means, suction attachment, adhesive attachment, mechanical attachment by small barbs, or clips, other minimally invasive means such as wires introduced through the entire thickness of the cavity wall and attached to the anchoring device on the internal side of the cavity, any combination of these modalities, or other non-invasive or minimally invasive anchoring means that might be envisioned for those accustomed to the art.
Additionally, in case the anchoring device is held in place by a device situated on the on exterior surface of a cavity such as the abdomen, these devices may serve also for lifting the cavity wall and permit performance of atmospheric pressure laparoscopy. The devices on the outer surface of the cavity can be attached to a frame or to rods fixed to the operating table, to the operating room floor or ceiling and serve for lifting the cavity wall, permitting to perform the intervention without the necessity to insufflate the cavity with gas.
Gas insufflation has its potential drawbacks such as generation of positive pressure, which in case of abdominal laparoscopy can be detrimental in obese patients, patients with chronic respiratory and/or cardiac diseases. Additionally gas insufflation, necessitates an insufflator device, can result in rapid loss of the working cavity when there is a gas leak, or when the gas exhaust resulting in inadequate view of the surgical site.
Laparoscopic interventions represent a significant advance in various fields of surgery permitting the performance of the majority of interventions through a number of small incisions reducing postoperative pain and enhancing the postoperative recovery. However there are still a significant number of drawbacks to this technique. The fixed position of the access openings in the wall of the cavity—access ports—significantly limits the approach to some surgical locations making some interventions very long and technically demanding. Creation of additional ports may negate the minimal invasive nature of the procedure. Some ports are used mainly for introducing retracting instruments in order to facilitate dissection.
The fixed position of the ports may hinder retraction in various directions, and the limited potential access sites (as for example anterior and lateral walls, but not posterior, proximal and distal walls of the abdomen for abdominal laparoscopy) may make retraction in some directions impossible.
Magnetic attraction has been used in medicine to remotely attach devices to tissue, or to remotely manipulate tissue. So, in U.S. Pat. No. 6,358,196, issued to RAYMAN REIZA magnetic substances are introduced into the intestine by ingestion and the intestines are remotely manipulated by an electromagnet during laparoscopic surgery. However this device does not permit retraction of an abdominal organ other than intestine and does not permit precise retraction of a particular segment of intestine.
In patents US2003009080, U.S. Pat. No. 6,494,211, a suction device is used to attach a retractor to various organs such as the heart in order to retract it in a specific direction. However these devices are introduced trough orifices in the body wall and they are not virtual ports since they can not permit non invasive anchoring of the retractor to the undersurface of the cavity wall, or within the cavity in another location than the access port.
In patents WO03013366, U.S. Pat. No. 6,206,827 a retractor device is attached to the organ to be retracted by some adhesive. However, the retractors are introduced through an orifice and does not represent a virtual port since they can not permit non invasive anchoring of the retractor to the undersurface of the cavity wall, or within the cavity in another location than the access port.
In U.S. Pat. No. 6,206,827, a retractor is directly attached to tissue by penetrating it with mechanical sharp means such as barbs or springs and traction on this means cause tissue retraction. However, the retractors are introduced through an orifice and does not represent a virtual port since they can not permit non invasive anchoring of the retractor to the undersurface of the cavity wall, or within the cavity in another location than the access port.
In patents EP1287786, U.S. Pat. No. 5,690,607 abdominal wall retractors that may be used for gasless laparoscopy are described. However, these devices can be used only for lifting the body wall and cannot be used, neither for anchoring endoscopic graspers, necessary for retracting intra-abdominal tissues and organs, nor for anchoring instruments at various position on the undersurface of the abdominal cavity. Additionally, when using rods for retraction, a few mm orifices are performed in the body wall.
There is a need for an anchoring device that is non invasively and removably attached to the undersurface of a cavity, or to various tissues within a cavity, or to tissues within a cavity, during minimally invasive surgery acting as an anchoring device for a retractor.
There is a need for an anchoring device, to which various retractors are attached, that is non invasively and removably attached to the interior surface of a cavity, or to various tissues within a cavity, and that can be moved to any other position easily.
There is a need for such an anchoring device that is non-invasively and removably attached to the interior surface of a cavity by magnetic attraction using a magnet or electromagnet on the exterior surface of the cavity.
There is a need for an anchoring device that is non-invasively and removably attached to the interior surface of a cavity, or to various tissues within a cavity, by using suction.
There is a need for an anchoring device that is non-invasively and removably attached to the interior surface of a cavity, or to various tissues within a cavity, by using suction in which the suction is applied continuously or in which the suction tube is detachable.
There is a need for an anchoring device that is non-invasive and removably attached to the interior surface of a cavity, or to various tissues within a cavity, by using a pressure sensitive gel or other reversible adhesive means.
There is a need for an anchoring device that is minimally invasive and removably attached to the interior surface of a cavity, or to various tissues within a cavity, using mechanical means such as barbs, or fixation wires.
There is a need for an anchoring device that is non-invasively or minimally invasively and removably attached to the interior surface of a cavity, that can permit lifting the cavity wall for performing gasless laparoscopy
There is a need for an anchoring device that is non-invasively and removably attached to the interior surface of a cavity, or to various tissues within a cavity, using any combination of the above means.
Applicant believes these needs are not answered in prior art, as well as other problems which will become apparent upon reading the present disclosure.